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2 Asymmetrical Drop in Hearing Infant identified from universal newborn hearing screening programme Bilateral refer on AABR with 35 dbnhl click stimulus Family history of hearing loss Maternal grandfather has loss from early childhood, now has a CI However father convinced hearing loss was due to screening not being done properly

9 Hearing Aid Fitting Fitting at approximately 4-5 months of age Parents wanted 2nd opinion, took child to United States to the House Ear Institute (who agreed with our results) Bilateral Phonak Bolero Q70 M13

11 Ongoing testing and monitoring Child receiving regular Auditory Verbal Therapy (AVT) sessions, parents were reasonably happy with his progress Very good hearing aid use, highly motivated parents Behavioural testing using VRA (Visual Reinforcement Audiometry) began at about 6 months of age in order to check progress with amplification and monitor behavioural thresholds

12 VRA at 8 months not conditioned, not responsive even to live voice

13 VRA at 9 months Still not ready for any frequency specific testing Monitored live voice testing at 50dBHL? Not very consistent with ABR thresholds

14 VRA at 10 months Parents and audiologists getting concerned over lack of responsiveness to sounds when being tested Everyone getting a bit stressed

15 VRA at 11 months Had to condition, then was interested, gave some searches, then gave up child became upset, dad concluded appointment Discussions begun about repeating ABR

16 VRA at 15 months 4 appointments later Finally started doing VRA Good reliability, but thought they might be supra-threshold

17 VRA at 16 months Very reliable Happy to tolerate inserts Now unexpected asymmetry apparent Everyone including parents want to have repeat ABR to check on thresholds

25 Current progress Fitted with a cochlear implant in his right ear and continues to wear his hearing aid in his left ear Doing very well and age appropriate for speech and language development Very robust cortical evoked potentials present

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Acknowledgments This guideline was revised and updated in July 2012 to add more current information and resources. The Connecticut Birth to Three System would like to thank the following people who worked

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